CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 94 96.250000 3580.5000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 79.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 88 216.750000 8053.8000 37.1571
Subtotal (Total Children Is Unduplicated) 101 392.000000 11634.3000 29.6793
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 31.500000 2362.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 34 63.000000 3496.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 19.500000 1462.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
Subtotal (Total Children Is Unduplicated) 50 138.500000 9081.0000 65.5668
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-T1013-INTERPRETER 2 7.000000 350.0000 50.0000
TRAV-TRAVS-Travel by mile 53 3883.000000 1708.6300 0.4400
Subtotal (Total Children Is Unduplicated) 53 3890.000000 2058.6300 0.5292
-----------------------------------------------------------------------------------------------------------------------
Total 4420.500000 22773.9300 5.1519
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 101
-----------------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 69 2434.000000 4052.3400 4016.7400
10 181.000000 339.7600 0.0000
Other 717 1805.500000 18381.8300 0.0000
---------------------------------------------------------
Total 796 4420.500000 22773.9300 4016.7400